# Update Course Rewind: Pediatric Biliary Stones - Preventing Gallstone Pancreatitis 2024 — GCMD Library Update Course Rewind: Pediatric Biliary Stones - Preventing Gallstone Pancreatitis 2024 | Podcast Episode on RSS.com Sign up free Features Resources Pricing Podcasts Sign up free Sign In Stay Current in Pediatric Surgery... Update Course Rewind: Pediatric B... Update Course Rewind: Pediatric Biliary Stones - Preventing Gallstone Pancreatitis 2024 Stay Current in Pediatric Surgery by StayCurrent: Pediatric Surgery Aug 6, 2025 03:54 RSS feed Website Listen on Share About Transcript Episode notes In this session from the 12th Annual Update Course in Pediatric Surgery, Drs. David Vitale, Luke Neff, and Jeffrey Ponsky explore strategies for preventing gallstone pancreatitis in pediatric patients with biliary stones. This session is classified as a Green Circle (established practice). Key Highlights: Managing complex cases: When to use conservative management with antibiotics for neutropenic, thrombocytopenic patients. Gallstone pancreatitis: How to differentiate management from typical choledocholithiasis cases. Timing of cholecystectomy: Why surgery should be based on clinical improvement rather than complete biochemical normalization. ERCP and IOC coordination: Determining when early ERCP is necessary and ... Read more Keywords update course pediatric surgery surgery update course rewind some4pedsurg prevention antibiotics choledocholithiasis cholecystectomy pancreatitis ERCP pediatric surgeons pediatric patients intraoperative cholangiography IOC pediatric gallstone billiary st Type: podcast · 3 min · posted 2026-07-29 Canonical: https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736 ## Chapters - [0:00](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=0) Introduction and Classification System - [0:53](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=53) Case Presentation: Neutropenic Patient with Cholecystitis - [1:39](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=99) Gallstone Pancreatitis Management - [3:11](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=191) Summary and Conclusion ## Statements - "The patient was a 16-year-old male currently undergoing treatment for acute lymphoblastic leukemia" — David Vitale (clinical) [0:53](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=53) - "The patient was neutropenic with markedly elevated liver function tests" — David Vitale (clinical) [1:05](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=65) - "Ultrasound findings were consistent with acute cholecystitis and choledocholithiasis" — David Vitale (clinical) [1:12](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=72) - "Over 50% of the audience poll opted to start antibiotics and address the elevated liver function tests" — David Vitale (opinion) [1:25](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=85) - "The patient spontaneously passed the stone and LFTs came back down" — David Vitale (clinical) [1:32](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=92) - "After counts recovered, the patient proceeded to elective cholecystectomy" — David Vitale (clinical) [1:36](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=96) - "Gallstone pancreatitis is inflammation of the pancreas triggered by a gallstone obstructing the bile duct, which can also impede pancreatic drainage" (clinical) [1:39](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=99) - "In gallstone pancreatitis, blockage prevents pancreatic enzymes from reaching the small intestine, leading them to accumulate and damage the pancreas" (clinical) [1:55](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=115) - "Some surgeons will do cholecystectomy within a few days for gallstone pancreatitis, while others wait for a week" (opinion) [2:05](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=125) - "From an ERCP standpoint, unless there's persistent biliary obstruction or cholangitis, ERCP is not performed right away" (clinical) [2:15](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=135) - "When symptoms are improving, biochemical normalization is not required before proceeding to cholecystectomy" — David Vitale (clinical) [2:24](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=144) - "Cholecystectomy is performed with intraoperative cholangiogram and coordination with ERCP team in case there might be a need" — David Vitale (clinical) [2:31](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=151) - "Studies show that if you wait one day when the patient comes in with acute biliary pancreatitis and amylase lipase go up, then ERCP is indicated for an impacted stone" (clinical) [2:38](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=158) - "Most of the time in gallstone pancreatitis, amylase and lipase will go right down as the stone passes spontaneously" (clinical) [2:50](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=170) - "When biochemical markers start going down, patients have passed the stone and can proceed to cholecystectomy" (clinical) [2:56](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=176) - "Most stones can be cleared and some stones pass spontaneously" — David Vitale (clinical) [2:59](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=179) - "Local resources and what is available must be factored into management decisions" — David Vitale (opinion) [3:05](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=185) - "In neutropenic and thrombocytopenic patients with cholecystitis and choledocholithiasis, initial conservative management with antibiotics can be effective, particularly when spontaneous stone passage occurs" — Em Gaudi (clinical) [3:11](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=191) - "For gallstone pancreatitis, early ERCP is typically reserved for cases with persistent biliary obstruction or cholangitis, as many patients improve without intervention" — Em Gaudi (clinical) [3:25](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=205) - "Timing of cholecystectomy should be based on clinical improvement rather than complete biochemical normalization" — Em Gaudi (clinical) [3:35](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=215) ## Transcript Global Cast MD, along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe. Hello, pediatric surgery family. I'm Em Gaudi from Cincinnati Children's Hospital Medical Center. In this video series, we'll be recapping the sessions and sharing the key highlights from our 12th annual update course in pediatric surgery, which was held in August 2024. This year, we introduced a new approach to classify practice-changing ideas at our update course. Presentations now fall into three categories. Green Circle for established practice, Blue Square for promising newer practice, and Black Diamond for early adopter practice only. In this video, Drs. David Vitale, Luke Neff, and Jeff Ponsky will talk about how to prevent gallstone pancreatitis in pediatric biliary stone cases. This session is classified as a Green Circle for established practice. This is a 16-year-old male. This is actually a patient of mine from about four months ago. This patient, currently undergoing treatment for acute lymphoblastic leukemia, or ALL, presents with right upper quadrant pain. He's neutropenic, has markedly elevated liver function tests, and ultrasound findings are consistent with acute cholecystitis and cholecystitis. So now we have a little bit more of a different situation with the neutropenic thrombocytopenic patient. What are we going to do? According to our live and virtual audience poll, over 50% opted to start antibiotics and address the elevated liver function tests. And that's the exact approach Dr. Neff took. And he spontaneously passed the stone. LFTs came back down. We were able to get him, his counts recovered, and get him to elective cholecystectomy. And I want to bring up one other scenario, too, for the audience, which is gallstone pancreatitis, which I think is a little bit different than our conventional show up with a stone in the duct. Gallstone pancreatitis is inflammation of the pancreas triggered by a gallstone obstructing the bile duct, which can also impede pancreatic drainage. This blockage prevents pancreatic enzymes from reaching the small intestine, leading them to accumulate and damage the pancreas. So the question is, how would you manage this patient? In my experience, some surgeon will go in and say, hey, we're going to do the cholecystectomy within a few days. Some will say, hey, we're going to wait for a week. From an ERCP standpoint, unless there's a persistent biliary obstruction or cholangitis, we're not jumping in to go do this case right away. So I just want to hear from folks about gallstone pancreatitis. When things are improving, we don't need to see biochemical normalization. But when the symptoms are improving, we go right to cholecystectomy with intraoperative cholangiogram and coordinate with you just in case there might be a need for an ERCP. There's been some studies done to show if you wait one day when the patient comes in with acute biliary pancreatitis, if the amylase lipase go up, then you do the ERCP because you have it impacted. But most of the time, it will go right down. And if it starts going down, they pass the stone and you can go to cholecystectomy. This is just from my standpoint, most stones can be cleared. Some stones pass spontaneously, right? We have to use good judgment with that. And local resources, you have to factor in what you have available to you. In summary, in neutropenic and thrombocytopenic patients with cholecystitis and cholangicholatiasis, initial conservative management with antibiotics can be effective, particularly when spontaneous stone passage occurs. For goalstone pancreatitis, early ERCP is typically reserved for cases with persistent biliary obstruction or cholangitis, as many patients improve without intervention. The timing of cholecystectomy should be based on clinical improvement rather than complete biochemical normalization, with intraoperative cholangiogram and ERCP coordinated as needed. Thank you for watching this video. GlobalCastMD, along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe. --- Not medical advice · citation policy: https://library.globalcastmd.com/ai